Hernia Repair Types

There are many different kinds of hernia repair, but the three major categories are:

Tension repair

Open tension-free repair

Laparoscopic tension-free repair

Tension Repair

For a long time, tension repair was the only repair option available to people with hernias. In this procedure, the surgeon makes an incision in the abdomen over the hernia site, pushes any protruding tissue back into the correct position within the abdominal cavity, and then stitches it closed. This type of repair is called a tension repair because the stitches or sutures put tension on either side of the defect in order to keep it closed. For many reasons, including pain and patient discomfort, a long recovery period, and high recurrence rates, physicians began moving to tension-free repair techniques.

Tension-free Repair

Tension-free repair techniques utilize a piece of mesh to bridge the hernia defect, and are the most common today. They are considered the gold standard of hernia repair by the American College of Surgeons. Today's mesh products are state-of-the-art in their ability to be strong yet lightweight.

Flat Mesh Repair After making an incision over your hernia, your surgeon will use a patch made out of flat plastic - like (polypropylene) mesh and stitch it to the tissue surrounding your hernia.

Advantages:

Hernias recur in only 3 percent of flat mesh repair patients

Patients experience a quick recovery

Only minor discomfort following procedure

Can be done under local anesthesia

Disadvantages:

If the hernia is large, more stitches may be required to fasten the mesh, increasing the risk of nerve damage, which could result in pain

Procedure can take between 40 and 60 minutes

Today's mesh products are state-of-the-art in their ability to be strong, yet lightweight.

Three-Dimensional Mesh Repair Three-dimensional mesh devices such as PROLENE* polypropylene Hernia System and PROLENE* 3D Patch polypropylene Mesh ( both manufactured by ETHICON Products Worldwide, a Johnson & Johnson company ) - have revolutionized the repair of hernias by building upon the advantages of the earlier tension-free techniques and making them even more effective.

PROLENE hernia system a "3-in-1" design (meaning that it incorporates three of the most widely used and accepted repair techniques into one single device) consist of three components integrated into one device:

An underlay patch that provides an effective posterior repair on the inside of the abdominal wall, much like laparoscopic repair.

An onlay patch that lays over the abdominal wall, much like a flat mesh repair

A low-profile connector that connects the underlay patch on the onlay patch. This connector virtually eliminates the possibility of the device from moving, or migrating, thus significantly reducing the potential for recurrence.

The system sandwiches tissue between two layers of mesh, which supplements potentially weak areas of the abdominal wall and minimizes the chances of getting another hernia in the same area. The patch helps the body heal by acting as a matrix for tissue ingrowth.

Advantages:

Patient Comfort

Virtually zero chance of migration

Little suturing, reducing the risk of nerve damage that could lead to pain

Can be done under local or regional anesthesia

Takes typically about 20-40 minutes

Quick recovery and return to normal activities

Extremely low recurrence rates

Another breakthrough device, the PROLENE 3D Patch mesh, is a one-piece mesh device that affords surgeons secure, low profile repairs. It is typically used for small hernias. The device consists of an overlay patch with a three-dimensional diamond-shaped underlay. The underlay is inserted into the hernia "hole" or defect, and then the surgeon pulls a string attached to the bottom of the diamond to "deploy" it. When deployed, the underlay becomes flat and forms a secure layer of mesh on the underside of the muscle wall.

Laparoscopic Repair

Surgeons have been performing laparoscopic repairs for the past decade. Although these procedures have been less widely used in the past, more and more surgeons are learning and perfecting this minimally invasive technique. In laparoscopic surgery, your surgeon makes a small incision and creates a space under the muscle in your abdomen with a balloon device. They will then insert a cannula, or slender tube, into your abdomen, which acts as a channel to the inside. Through this space, the surgeon inserts the laparoscope, which is a thin telescope, and views the hernia and surrounding tissue on a video screen. The surgeon must then insert two to three additional cannulas through small abdominal incisions. The hernia sac is removed and a piece of surgical mesh inserted, which is held in place with small surgical staples. This surgery is called posterior hernia repair because the hernia is being repaired from behind the abdominal wall. It differs from traditional mesh repairs (discussed above), in which the mesh is placed on the outside of the abdominal wall.

During the procedure, the surgeon needs to clearly visualize the underlying anatomy in order to put a piece of mesh in the proper place. Some mesh products are designed to make this easier. For example, the new ULTRAPRO* Partially Absorbable Lightweight Mesh has highly visible blue stripes to aid the surgeon with orientation and placement of the mesh.

Advantages:

Pressure from within the abdominal cavity helps to hold the mesh in place

Minimally invasive repair, which may mean less pain and shorter recovery time

Allows for visualization of undiagnosed hernias

May have advantages in repair of bilateral and recurrent hernias

Disadvantages:

Must be performed under general anesthesia, the riskiest part of any surgical procedure

Can require an overnight stay in the hospital

Procedure can take 60 minutes.

There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.

This type of surgery may not be appropriate for patients who:

Are pregnant

Cannot tolerate general anesthesia

Have a severe lung disease

Have had multiple previous abdominal surgeries

Have a bleeding disorder or are taking medications to prevent blood clots

Are obese

Advantages:

Hernias recur in only 3% of flat mesh repair patients

Quick recovery

Only minor discomfort following procedure

Can be done under local anesthesia

Disadvantages:

If the hernia is large, more stitches may be required to fasten the mesh, increasing the risk of nerve damage, which could result in pain

Procedure can take between 40 and 60 minutes

Today's mesh products are state-of-the-art in their ability to be strong yet lightweight.

Three-Dimensional Mesh Repair Three-dimensional mesh devices such as PROLENE* polypropylene Hernia System and PROLENE* 3D Patch polypropylene Mesh ( both manufactured by ETHICON Products Worldwide, a Johnson & Johnson company ) - have revolutionized the repair of hernias by building upon the advantages of the earlier tension-free techniques and making them even more effective.

PROLENE hernia system a "3-in-1" design (meaning that it incorporates three of the most widely used and accepted repair techniques into one single device) consist of three components integrated into one device:

An underlay patch that provides an effective posterior repair on the inside of the abdominal wall, much like laparoscopic repair.

An onlay patch that lays over the abdominal wall, much like a flat mesh repair

A low-profile connector that connects the underlay patch on the onlay patch. This connector virtually eliminates the possibility of the device from moving, or migrating, thus significantly reducing the potential for recurrence.

The system sandwiches tissue between two layers of mesh, which supplements potentially weak areas of the abdominal wall and minimizes the chances of getting another hernia in the same area. The patch helps the body heal by acting as a matrix for tissue ingrowth.

Advantages:

Patient Comfort

Virtually zero chance of migration

Little suturing, reducing the risk of nerve damage that could lead to pain

Can be done under local or regional anesthesia

Takes typically about 20-40 minutes

Quick recovery and return to normal activities

Extremely low recurrence rates

Another breakthrough device, the PROLENE 3D Patch mesh, is a one-piece mesh device that affords surgeons secure, low profile repairs. It is typically used for or small hernias. The device consists of an overlay patch with a three-dimensional diamond-shaped underlay. The underlay is inserted into the hernia "hole" or defect, and then the surgeon pulls a string attached to the bottom of the diamond to "deploy" it. When deployed, the underlay becomes flat and forms a secure layer of mesh on the underside of the muscle wall.

Laparoscopic Repair Surgeons have been performing laparoscopic repairs for the past decade. Although these procedures have been less widely used in the past, more and more surgeons are learning and perfecting this minimally invasive technique. In laparoscopic surgery, your surgeon makes a small incision and creates a space under the muscle in your abdomen with a balloon device. They will then insert a cannula, or slender tube, into your abdomen, which acts as a channel to the inside. Through this space, the surgeon inserts the laparoscope, which is a thin telescope, and views the hernia and surrounding tissue on a video screen. The surgeon must then insert 2 to 3 additional cannulas through small abdominal incisions. The hernia sac is removed and piece of surgical mesh inserted, which is held in place with small surgical staples. This surgery is called posterior hernia repair because the hernia is being repaired from behind the abdominal wall. It differs from traditional mesh repairs (discussed above), in which the mesh is placed on the outside of the abdominal wall.

During the procedure, the surgeon needs to clearly visualize the underlying anatomy in order to put a piece of mesh in the proper place. Some mesh products are designed to make this easier. For example, the new ULTRAPRO* Partially Absorbable Lightweight Mesh has highly visible blue stripes to aid the surgeon with orientation and placement of the mesh.

Advantages:

Pressure from within the abdominal cavity helps to hold the mesh in place

Minimally invasive repair, which may mean less pain and shorter recovery time

Allows for visualization of undiagnosed hernias

May have advantages in repair of bilateral and recurrent hernias

Disadvantages:

Must be performed under general anesthesia, the riskiest part of any surgical procedure

Can require an overnight stay in the hospital

Procedure can take 60 minutes.

There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves or the sperm tube going to the testicle.

This type of surgery may not be appropriate for patients who:

Are pregnant

Cannot tolerate general anesthesia

Have a severe lung disease

Have had multiple previous abdominal surgeries

Have a bleeding disorder or are taking medications to prevent blood clots